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Please complete this survey even if your business does not currently use scanning technology. Please ask other employees if you do not know the answer to a particular question. For questions that ask for numbers or percentages, your best estimate is acceptable. For purposes of this survey, certain words have particular meanings, so please refer to the definitions provided. Unless otherwise indicated, please choose one answer for each question.
Answer all the questions by completely filling in the box to the left of your answer. You are sometimes told to skip over some questions in this survey. When this happens, you will see an arrow with a note that tells you what question to answer next, like this:
Yes
No GO TO QUESTION 4
Please return the completed survey within 2 weeks. The last page provides instructions on how to return the survey.
Is this store currently authorized to accept SNAP benefits?
Yes
No Complete Sections 1 and 2 and then return the survey.
Does the owner of this store own and operate any stores at other locations?
Yes
No GO TO QUESTION 4
How many other stores are owned and operated by this store’s owner?
1–3
4–6
7–9
10 or more
NOTE:
For the remainder of the survey, all questions only concern the
store location as identified at the top of this survey.
How many cash registers/lanes are currently used by this store?
1
2
3
4
5
6 or more
How does this store connect to the Internet?
Dial-up telephone line
High-speed Internet connection (e.g., cable TV modem, fiber optic connection)
This store does not have an Internet connection
Other (Please specify): _________________________
Is this store also a WIC-authorized vendor? WIC refers to the Women, Infants, and Children Program.
Yes, use paper vouchers
Yes, use Electronic Benefit Transfer system (eWIC)
No
How many unique barcode food products are sold in this store? Do not include products that are sold by weight. Remember that your best estimate is fine.
Fewer than 100
100 to 499
500 to 999
1,000 to 2,999
3,000 to 4,999
5,000 to 9,999
10,000 to 14,999
15,000 to 20,000
More than 20,000
How many other unique food products are sold in this store that do not have a barcode? These items are sometimes sold by weight and can include meat, fruit, vegetables and other items. Your best estimate is fine.
None
1 to 24
25 to 49
50 to 99
100 to 499
500 to 999
More than 1,000
How many full-time employees are currently employed at this store (including yourself, if appropriate)? By full time, we mean working at least 35 hours per week.
0
1 or 2
3 or 4
5–9
10–14
15–20
More than 20
How many part-time employees are currently employed at this store (including yourself, if appropriate)? By part time, we mean working fewer than 35 hours per week.
0
1 or 2
3 or 4
5–9
10–14
15–20
More than 20
How many of your full- or part-time employees are primarily responsible for checking out customers?
0
1 or 2
3 or 4
5–9
10–14
15–20
More than 20
The following questions ask about your store’s front-end register system and use of scanning technologies. By front-end register system, we mean the customer service/checkout lanes featuring a cash register and payment terminal.
Is your store’s front-end register system integrated with the EBT payment terminal?
Yes
No, we must enter SNAP transactions in both the register and payment terminal.
Is the payment terminal(s) owned by the store or is it leased? [Select all that apply]
Owned
Leased
Other (Please specify): ___________________
Who maintains and upgrades your store’s front-end register system?
Store employee Specify job title of this person: _________________________
Service company or consultant
No one
Other (Please specify): _________________________
Does your store’s register system scan barcodes on products during checkout?
Yes, currently operational
Yes, in the process of purchasing/installing
No GO TO QUESTION 17
Does your store’s register system indicate whether products are eligible for purchase with SNAP benefits (for example, by using a flag or other indicator)?
Yes, currently operational You have completed the survey
Yes, in the process of purchasing/installing You have completed the survey
No ANSWER QUESTIONS 17 AND 18
There is a new law that will require all SNAP-authorized retailers to use scanners at checkout to accept SNAP benefits. In the future, your store may need to upgrade or purchase and maintain new equipment to comply with this law. How likely are you to do this so you can remain a SNAP-authorized retailer?
Very unlikely
Somewhat unlikely
Neither unlikely nor likely
Somewhat likely
Very likely
In the table below, indicate how important each of the factors would be in your decision on whether to upgrade or purchase scanning technology that meets the new requirement.
|
Factor |
Very Unimpor-tant |
Somewhat Unimpor-tant |
Neither Unimpor-tant nor Important |
Somewhat Important |
Very Important |
a. |
Slow or unreliable Internet access |
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b. |
Cost to purchase, install, and maintain scanner |
|
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c. |
Lack of technical knowledge |
|
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d. |
Limited checkout stand space |
|
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e. |
Unreliable electrical power causes frequent outages |
|
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f. |
Low SNAP sales volume |
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g. |
Possible disruption of store operations during installation |
|
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h. |
Cost to train staff |
|
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i. |
Time to train staff |
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j. |
No one available to help with system failures and other troubleshooting |
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k. |
Time to evaluate and decide which type of scanner to install |
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l. |
Staff have limited English-speaking ability |
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m. |
Time to maintain product database |
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Thank you for filling out the survey!
Please return the survey in the enclosed prepaid envelope to RTI International, Attn: Data Capture (0215527.000.001.005.003) at 5265 Capital Blvd., Raleigh, NC 27690-1653.
According
to the Paperwork Reduction Act of 1995, no persons are required to
respond to a collection of information unless it displays a
valid OMB number. The valid OMB control number for this information
collection is 0584-XXXX. The time required to complete this
information collection is estimated to average 15 minutes per
response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of
information.
Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Protocols and Guidelines Manual |
Subject | Home Health Care CAHPS Survey |
Author | Centers for Medicare & Medicaid Services |
File Modified | 0000-00-00 |
File Created | 2021-01-22 |